Mazlum Serdar AKALTUN, Özlem ALTINDAĞ, Neytullah TURAN, Ali AYDENİZ, Savaş GÜRSOY, Ali GÜR

Ankilozan spondilit hastalarında metabolik sendrom ile vitamin D düzeyi arasındaki ilişki

Amaç: Bu çalışmanın amacı, Ankilozan Spondilit (AS) hastalarında D vitamin seviyesi ile Metabolik Sendrom (MetS) gelişimi arasındaki ilişkiyi ortaya koymaktır. Gereç ve Yöntem: Kesitsel tanımlayıcı tipteki bu çalışmaya 67 AS hastası dahil edildi. Sosyo-demografik veriler, bel çevresi ve sistolik kan basıncı değerlendirildi. Açlık kan şekeri, HDL kolesterol, Trigliserid ve Vitamin D değerleri kaydedildi. MetS teşhisi, Ulusal Kolesterol Eğitim Programının Yetişkin Tedavi Paneli'ne (NCEP / ATP III) gore yapılmıştır. Hastalık aktivitesi ve yaşam kalitesi değerlendirildi. Bulgular: Bu çalışmada AS hastalarında Vitamin D seviyeleri ile MetS arasında anlamlı negatif bir ilişki tespi tedildi. HDL seviyeleri ve Vitamin D seviyeleri MetS'li hastalarda anlamlı olarak daha düşüktü. Çoklu regresyon analizi, MetS'nin BMI, Trigliserit seviyesi, açlık glikozu ile pozitif olarak ilişkili olduğunu ve HDL kolesterol ve Vitamin D ile negatif olarak ilişkili olduğunu gösterdi. Sonuç: Bu çalışma, AS'li hastalarda MetS gelişiminde D vitamininin rolü olabileceğini göstermektedir. Bununla birlikte, ankilozan spondilitli hastalarda D vitamin ve metabolik sendrom arasındaki ilişkiyi açıklamak için daha fazla çalışmaya ihtiyaç vardır.

Relationship between metabolic syndrome and vitamin D level in patients with ankylosing spondylitis

Purpose: The purpose of this study is to reveal the relationship between the level of Vitamin D and the development of Metabolic Syndrome (MetS) in patients with Ankylosing Spondylitis (AS). Materials and Methods: 67 AS patients were included in this cross-sectional descriptive study. Socio-demographic data, waist circumference and systolic blood pressure were evaluated. Fasting blood glucose, HDL cholesterol, Triglyceride and Vitamin D values were recorded. Diagnosis of MetS was made according to National Cholesterol Education Program’s Adult Treatment Panel (NCEP/ATP III). Disease activity and quality of life were assessed. Results: In the present study, a significantly negative correlation was detected between Vitamin D levels and MetS in AS patients. HDL levels and Vitamin D levels were significantly lower in patients with MetS. Multiregression analysis showed that MetS was positively associated with BMI, Triglyceride level, fasting glucose and negatively associated with HDL cholesterol and Vitamin D. Conclusion: This study shows that vitamin D may have a role in the development of MetS in patients with AS. However, more studies are needed to explain the relationship between vitamin D and metabolic syndrome in patients with ankylosing spondylitis.

Keywords:

Ankylosing Spondylitis, Anti-Tumor Necrosis Factor-Alpha, Cardiovascular Risk, Metabolic Syndrome, Vitamin D,

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1. Dougados M, Baeten D. Spondyloarthritis. Lancet. 2011;377(9783):2127-37.
2. Daikh DI, Chen PP. Advances in managing ankylosing spondylitis. F1000Prime Reports. 2014;6:78.
3. Dessein PH, Stanwix AE, Moomal Z. Rheumatoid arthritis and cardiovascular disease may share similar risk factors. Rheumatology. 2001;40:703-4.
4. Divecha H, Sattar N, Rumley A, Cherry L, Lowe GD, Sturrock R. Cardiovascular risk parameters in men with ankylosing spondylitis in comparison to non-inflammatory control subjects: relevance of systemic inflammation. Clin Sci (Lond). 2005;109:171-6.
5. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA et al. Diagnosis and Management of the Metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–52.
6. National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). Third report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation. 2002;106(25):3143–421.
7. Stern MP, Williams K, Gonza´lez-Villalpando C, Hunt KJ, Haffner SM. Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease?. Diabetes Care. 2004;27(11):2676–81.
8. Chen J, Muntner P, Hamm LL, Jones DW, Batuman V, Fonseca V et al. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med. 2004;140:167–74.
9. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165(5):670–6.
10. Gouni-Berthold I, Krone W, Berthold HK. Vitamin D and cardiovascular disease. Curr Vasc Pharmacol 2009;7(3):414–22.
11. Pinelli NR, Jaber LA, Brown MB, Herman WH. Serum 25-hydroxy vitamin d and insulin resistance, metabolic syndrome, and glucose intolerance among Arab Americans. Diabetes Care. 2010;33:1373-5.
12. Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-Hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168(11):1174–80.
13. Han C, Robinson DW, Hackett MV, Paramore LC, Fraeman KH, Bala MV. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol. 2006;33:2167-72.
14. Peters MJ, Van der horst-Bruinsma IE, Dijkmans BA, Nurmohamed MT. Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum. 2004;34:585-92.
15. Malesci D, Niglio A, Mennillo G, Buono R, Valentini G, La Montagna, G. High prevalence of metabolic syndrome in patients with ankylosing spondylitis. Clinical rheumatology. 2007;26(5):710.
16. Maia DG, Augusto KL, Bezerra MC, Rodrigues CEM. Metabolic syndrome in patients with ankylosing spondylitis receiving anti-TNFα therapy: association with predictors of cardiovascular risk. Clinical rheumatology. 2017;36(10):2371-76.
17. Holick MF.Vitamin D deficiency. N Engl J Med. 2007;357: 266–81.
18. Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JPA. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ. 2014;348:2035.
19. Zhao S, Duffield SJ, Moots RJ, Goodson NJ. Systematic review of association between vitamin D levels and susceptibility and disease activity of ankylosing spondylitis. Rheumatology. 2014;53(9):1595-603.
20. Erten S, Kucuksahin O, Sahin A, Altunoglu A, Akyol M, Koca C. Decreased plasma vitamin D levels in patients with undifferentiated spondyloarthritis and ankylosing spondylitis. Internal Medicine. 2013;52(3):339-44.
21. Zhao SZ, Thong D, Duffield S, Goodson N. Vitamin D Deficiency in Axial Spondyloarthritis is Associated With Higher Disease Activity. Archives of Rheumatology. 2017;32(3):209.
22. Song HR, Park CH. Low serum vitamin D level is associated with high risk of metabolic syndrome in post-menopausal women. Journal of endocrinological investigation. 2013;36.10: 791-96.
23. Wang CM, Chang CS, Chang YF, Wu SJ, Chiu CJ, Hou MT et al. Inverse Relationship between Metabolic Syndrome and 25-Hydroxyvitamin D Concentration in Elderly People without Vitamin D deficiency. Scientific reports. 2018;8(1):17052.
24. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007;92:2017–29.
25. Al-Shoumer K A, Al-Essa TM. Is there a relationship between vitamin D with insulin resistance and diabetes mellitus? World J Diabetes. 2015;6(8):1057 .
26. Strange RC, Shipman KE, Ramachandran S. Metabolic syndrome: A review of the role of vitamin D in mediating susceptibility and outcome. World J Diabetes. 2015;6(7):896.
27. Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey. Am J Hypertens. 2007;20(7):713–19.
28. Li YC, Qiao G, Uskokovic M, Xiang W, Zheng W, Kong J. Vitamin D: a negative endocrine regulator of the renin–angiotensin system and blood pressure. J. Steroid Biochem Mol Biol. 2004;89:387–92.
29. Jorde R, Figenschau Y, Emaus N, Hutchinson M, Grimnes G. Serum 25-hydroxyvitamin D levels are strongly related to systolic blood pressure but do not predict future hypertension. Hypertension. 2010;55(3): 792–98.
30. Hewison M. Vitamin D and immune function: an overview. Proc Nutr Soc. 2012;71(1):50–61.